Provider Demographics
NPI:1831541101
Name:MCWILLIAMS, KEITH BENJAMIN (OTR/L, OTD, CBIS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:BENJAMIN
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:OTR/L, OTD, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 CLAIRBORNE DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8203
Mailing Address - Country:US
Mailing Address - Phone:832-360-5444
Mailing Address - Fax:
Practice Address - Street 1:2424 CLAIRBORNE DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8203
Practice Address - Country:US
Practice Address - Phone:832-360-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113868225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist